How Overactive Bladder Is Diagnosed

Although as many as one in six women and one in four men in the United States may have overactive bladder (OAB), it can be a difficult condition to diagnose. As a disorder characterized by the sudden and frequent urge to urinate, OAB is diagnosed mainly by its signs and symptoms but only after other likely causes have been excluded.

Urine sample ready for a urinalysis
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Because the symptoms of OAB mimic those of other urological conditions, patience may be needed while multiple tests and procedures are performed. Even so, bladder conditions are frequently misdiagnosed due to their nonspecificity, and it can take time before the right treatment is found.

OAB is not a disease. It is a complex group of symptoms that, while distressing and uncomfortable, is generally not life-threatening.

Self-Checks

Most people will seek the diagnosis of OAB when the symptoms are causing embarrassment or are interfering with their quality of life. Because the causes of OAB are widespread, recognition of the four characteristic symptoms is key to reaching a correct diagnosis.

These include:

  • Urinary frequency: The need to urinate more than seven times within a 24-hour period
  • Urinary urgency: The sudden urge to urinate that's difficult to control
  • Nocturia: The need to urinate more than once nightly
  • Urge incontinence: The unintentional loss of urine after the sudden urge to urinate

Not everyone experiences OAB in the same way. Although urinary frequency and urgency are considered hallmarks of the disorder, some people may experience nocturia more profoundly than others, for example.

Some may experience urinary incontinence (referred to as "wet OAB") either mildly or severely, while others may have no incontinence at all (referred to as "dry OAB").

Urge incontinence differs from other types of urinary incontinence—such as stress incontinence, overflow incontinence, or postpartum incontinence—in that the leakage is preceded by the sudden, uncontrollable urge to urinate.

Understanding these distinctions can help you better describe your symptoms when you see a healthcare provider.

Bladder Diary

To aid in the diagnosis, you can keep a record of your daily and nightly urinations using a bladder diary. The aim of the diary is not only to record the timing of your urinations but also what happened prior to and at the time of the event.

A bladder diary should keep a record of:

  • When you consume liquids each day, including how much and what you drink (e.g., soda, coffee, water)
  • Your bathroom trips, including an estimate of how much urine you void
  • When you have accidental leakage and how much is involved
  • Whether the accidental leakage was preceded by the sudden urge to urinate
  • What you are doing at the time of the event (such as laughing, sneezing, running, or simply sitting at your desk)

With an accurate record, your healthcare provider may be able to pinpoint the cause of your symptoms quicker.

Physical Examination

OAB is a complex disorder best evaluated by a specialist in urinary tract disorders, called a urologist. Urologists are skilled in differentiating the conditions that cause urinary frequency and incontinence, thereby reducing the risk of misdiagnosis.

The first step in the diagnosis is the physical exam. As part of the evaluation, your healthcare provider will review your symptoms and medical history and ask questions about your lifestyle, behaviors, diet, and medication use.

Each of these areas can provide clues as to the underlying cause of your symptoms and help your healthcare provider select the appropriate tests and procedures to pursue.

The healthcare provider will start by taking your blood pressure and measuring your height and weight to determine your body mass index (BMI). Hypertension (high blood pressure) and obesity (a BMI of 30 and over) are both considered independent risk factors for OAB.

As for the exam itself, you may be asked to undress and put on a hospital gown. The exam will try to eliminate other possible causes of your symptoms and may involve:

  • Abdominal exam: To look for evidence of a hernia, abdominal masses, organ enlargement (organomegaly), surgical scars, or bladder distention
  • Pelvic exam: To look for signs of uterine prolapse, prolapsed bladder (cystocele), the thinning of the vaginal wall (atrophic vaginitis), and the outgrowth of the urethra (urethral caruncle) caused by things like pregnancy and menopause, or other anatomical changes
  • Digital rectal exam: To look for abnormal growths or the loss of sphincter tone in all patients, and an enlarged prostate (benign prostatic hyperplasia) in people with a prostate

Labs and Tests

There are no laboratory tests that can definitively diagnose OAB. More often than not, urine tests and blood tests are performed to exclude other possible causes of your symptoms.

Urinalysis

During your initial evaluation, you will be asked to provide a urine sample for the lab. The main purpose of the urinalysis is to check for any abnormalities in your urine, such as:

Blood Tests

In some cases, a urinalysis, physical exam, and comprehensive review of a person's symptoms and medical history are all that are needed to diagnose OAB. At other times, additional tests may be necessary to validate the diagnosis.

Blood tests serve much the same purpose as a urinalysis. They are generally pursued if you are at an increased risk of a urological condition or are suspected of having one.

These blood tests may include:

Imaging

Imaging studies are less commonly used in the initial diagnosis of OAB. More often, they may be called for when symptoms are severe or there are other concerns related to the proper functioning of the bladder.

Bladder ultrasonography, or bladder ultrasound, a noninvasive procedure that uses high-frequency sound waves to create images of the bladder and surrounding structures, is the most common imaging test.

An ultrasound can reveal abnormalities suggestive of OAB or point the healthcare provider in the direction of other bladder-related conditions. Two reasons for ultrasound include:

  • Bladder wall hypertrophy: The thickening of the bladder wall is commonly associated with an overactive detrusor muscle (the muscle that contracts and relaxes the bladder) and OAB.
  • Post-void residual (PVR): PVR evaluates the amount of urine left in the bladder after urination, a condition commonly experienced in people with an enlarged prostate, neurogenic bladder (bladder dysfunction caused by neurological damage), traumatic bladder injury, or urinary tract obstruction

In addition to ultrasonography, PVR may involve a urinary catheter to suction the remaining urine in order to measure the post-void volume.

Other, more invasive imaging techniques may be used if the urinary incontinence is severe or if there is evidence of bladder damage, urinary reflux, or neurogenic bladder. These may include bladder fluoroscopy or urodynamics (used to measure abnormal contractions and spasms while the bladder is filled and emptied).

Other Procedures

Other procedures may be performed if the causes of your urological symptoms remain unclear or if you fail to respond to the prescribed treatment for OAB.

These typically in-office procedures include:

  • Cystometry: Warm fluid is fed into the bladder with a urinary catheter while another catheter with a pressure-sensitive probe is fed into the rectum or vagina to measure the pressure needed to void the bladder
  • Uroflowmetry: While you urinate into a device called a uroflowmeter, a measurement is taken of the rate of urine flow and any changes in the flow pattern

These tests are often most beneficial to people with intractable (treatment-resistant) incontinence, who may need surgery.

Differential Diagnosis

The challenge of diagnosing OAB is that it can mimic many other conditions, including those not directly involving the bladder. Expert consultation is needed to reach a correct diagnosis and ensure that all other likely causes have been reasonably explored.

Among the conditions commonly included in the differential diagnosis are:

Condition Affecting Differential
Benign prostatic hyperplasia (BPH) Men BPH is characterized by the gradual rather than sudden onset of symptoms along with weak urine flow.
Bladder cancer Women and men Bladder cancer often causes pain with urination, blood in urine, and lower back pain on one side of the body.
Bladder outlet obstruction (BOO) Women and men BOO is characterized by stop-and-go urination, pelvic pain, weak urine flow, and straining to urinate.
Bladder stones Women and men Bladder stones often cause severe lower abdominal pain, pain with urination, and blood in urine.
Cystitis More common in women Cystitis often causes pain with urination, cloudy urine, blood in urine, lower abdominal pain, and a general feeling of unwellness.
Diabetes insipidus Women and men This complication of diabetes is associated with increased thirst, fatigue, dry skin, and often profuse urination but without any urgency.
Neurogenic bladder  Women and men Neurogenic bladder often manifests with dribbling urine, small urine volumes, and a loss of feeling that the bladder is full.
Pelvic organ prolapse (POP) Women POP typically causes a heaviness in the pelvic floor and a feeling as if a bulge or lump is coming out of the vagina.
Prostate cancer Men Prostate cancer often causes blood in urine or semen, decreased urine flow, bone pain, pain with urination, and erectile dysfunction.
Urethral stricture Women and men The narrowing of the urethra can cause difficulty urinating, incomplete bladder emptying, and spraying when urinating.
Urinary tract infection (UTI) Women and men UTIs can cause pain with urination, cloudy urine, blood in urine, pelvic pain, and a general feeling of illness.
Vesicovaginal fistula Women Vesicovaginal fistula is often associated with gynecologic cancers and is characterized more by constant leakage than urinary urgency.

A Word From Verywell

Overactive bladder is a complex condition involving a combination of biological, physiological, and lifestyle factors.

Diagnosing OAB can take time, but by identifying the factors that contribute to it, many people can learn to manage the symptoms with not only medications but also lifestyle changes (such as fluid restriction and caffeine avoidance), pelvic floor exercises, and bladder training.

With the proper diagnosis and treatment, around 60% of people will achieve complete remission within a year, while others will experience a significant reduction in the frequency, discomfort, and stress associated with OAB.

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